In the world of sports medicine, injuries incurred by dancers can go toe-to-toe with those of more conventional athletes.
Though sometimes overshadowed by other athletics, medical researchers find injuries are prevalent among dancers, says Jeffrey A. Russell of the Ohio University School of Applied Health.
“Dancers are clearly athletes in the degree to which sophisticated physical capacities are required to perform at a high level,” Russell says in a report on the National Institutes of Health website. “The standard complement of athletic attributes – muscular strength and endurance, anaerobic and aerobic energy utilization, speed, agility, coordination, motor control, and psychological readiness – all are essential to dance performance.”
Athletes Over Artists
Unlike sports, from volleyball to soccer, where various players utilize many of the same muscles and joints in their execution, dance has more variation, which can make research challenging.
“Dance as an art form is a collective of a variety of genres, some of which are becoming increasingly difficult to categorize because they are influenced by two or more styles,” Russell says.
Ballet has gotten the lion’s share of research attention, the report says, followed by break dance and modern/contemporary dance. Other genres receiving less study include hip-hop, flamenco, ballroom and Irish dance.
Another obstacle to doing adequate research into risks for dancers, Russell finds, is the limitations on defining “injury,” which is often only when it results in time lost from the activity.
Dance Injuries in the Spotlight
Thomas M. Novella, DPM, describes in an article in Podiatry Today his experience working in a multidisciplinary dance-health facility in New York City, where he saw up to 30 dancers daily. He says surveys reported that 80 percent of dancers sustain career-threatening foot/ankle injuries, but he was able to treat dancers with the same concepts used by podiatric medicine’s founding fathers.
“Dance involved a fixed set of extreme positions, an archetypal soup for overuse injury,” Dr. Novella says. “It did not seem like there was an exact way to measure ankle ranges of motion. I was rattled by these challenges.”
He shares some of his wisdom from tackling those challenges, describing his treatment of typical injuries dancers experienced.
Ankle plantar flexion refers to movement of the ankle that points the foot downward. This is a necessary use of the foot for ballet and modern dancers to pointe and releve.
“Those who have less than 180 degrees may suffer posterior ankle impingement injuries or midtarsal floor bruises throughout their career,” Dr. Novella says.
Your chiropractor can use some of the treatments described by Dr. Novella, including analysis of a patient’s maximal active plantar flexion of the ankle. He or she can stand at eye level with the patient’s ankle and use a straight-edge to look for any angular deviation between the leg and the foot.
Ankle dorsiflexion with the knee flexed can occur when we experience calf fatigue as the result of squats or stairs, explains Dr. Novella.
“When a dancer has DKF, it is called a demi-plié,” it says. “The demi-plié is the position from which a dancer (and basketball player) accelerates each leap and absorbs landing shock.”
If a dancer has too little demi-plié, he says, the individual may incur anterior ankle impingements, or a pinching at the front of the ankle, which can create bone spurs.
To treat DKF, your chiropractor may use Dr. Novella’s technique where the patient lies face up while the medical professional holds the sole at 90 degrees, at the same time assisting the patient in flexing the knee until reaching ankle end-range of motion.
Hallux dorsiflexion with the ankle fully plantar flexed refers to your big toe’s ability to extend while your foot is pointing downward. It’s a dancer’s frequent landing, posturing, leaping and turning from the tiptoe position (demi-pointe) that causes dancers to experience HDP, according to Dr. Novella.
“The dancer’s hallux must dorsiflex 90 degrees to accommodate her or his plantar flexed ankle, an amount significantly higher than the non-dancer norm of 60 to 65 degrees,” he says.
This injury may make an individual susceptible to plantar plate injury, sprains or lateral ankle instability. Dancers often have to leave the industry due to HDP issues.
A chiropractor or other medical professional may treat HDP by assisting the patient in holding a maximum plantar flex of the ankle. Then the patient can dorsiflex, or point downward to the end range of motion.
Another frequent injury for dancers involves the Lisfranc Joint, according to FootHealthFacts.org, a website by the American College of Foot and Ankle Surgeons. The tarsal bones in your arch connect to the metatarsal bones, which are the long bones that go out to your toes. The Lisfranc ligament is the tissue in the area where these connect. It’s one of the most important aspects of alignment, says the article.
Dancing mishaps cause damage to the Lisfranc joint when the foot suffers from excessive force. The article says there are three types of Lisfranc injuries:
- Fractures: The Lisfranc joint bone can have an avulsion fracture, where a small piece of bone is pulled off, or a break through the bones of the mid-foot.
- Sprains: The Lisfranc ligament on the bottom of the mid-foot is stretched and weakened, creating instability in the patient.
- Dislocations: Lisfranc joint bones are forced from their normal positions.
Sometimes people mistakenly assume a Lisfranc injury is a sprained ankle, says the website. The symptoms you may experience in the case of a Lisfranc injury include:
- Pain throughout the mid-foot when standing
- Inability to bear weight
- Foot swelling
- Bruising or blistering on the arch or on top of the foot
- Abnormal widening of the foot
A chiropractor or other medical professional will typically diagnose and treat your injury to the Lisfranc ligament by initially questioning you about the cause of the injury, then examining the foot to determine the severity of the damage to evaluate whether it involves a fracture or weakening of the joint and surrounding bones.
The article suggests that you stay off your foot after an injury of this kind. To reduce swelling and get pain under control, you’re wise to keep it elevated, at least hip level, while applying ice every 20 minutes. Your chiropractic professional is likely to advise immobilization, and possibly the use of crutches.
“Complications can and often do arise following Lisfranc injuries,” the website says. “A possible early complication following the injury is compartment syndrome, in which pressure builds up within the tissues of the foot.”
The increasing pressure can cause damage to the nerves, blood vessels, and muscles in the foot. Not only that, it can lead to arthritis and destroy foot alignment.
Delaying the Swan Song
Russell’s review concludes by offering five essential components of treating dancers to decrease the likelihood of dance-related injuries:
- Physical training
- Nutrition and rest
- Specialized dance health care
- Becoming acquainted with the nature of dance
While research is limited when it comes to treatment of dancers, they’re prone to injury just like conventional athletes, which means chiropractic professionals need to stay on their toes.
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